Transthoracic Needle Biopsy

Abstract

By Sven Dahlgren, M.D., Department of Pathology, and Björn Nordenström, M.D., Director, Department of Thoracic Radiology, Karolinska Institutet, Stockholm, Sweden. Cloth, $12.50. Pp. 132, with 70 figures. Chicago, Yr. Bk. Pub'rs., 1966. This very good monograph reports in detail on a large clinical experience with transthoracic needle biopsy. The material is well organized, clearly presented, reads easily, and will be a useful basic reference work for all those interested in initiating this technic. The authors have shown quite conclusively that needle biopsy of pulmonary lesions under roentgen television control has been sufficiently developed to become a clinically valuable diagnostic tool. It provides the opportunity for obtaining specific diagnostic information in those lesions that otherwise would not be obtainable except through open thoracotomy and excisional biopsy. Although needle biopsy of pulmonary lesions is not a new procedure, it was never generally accepted as a safe and accurate diagnostic method. The recent ability to monitor the puncture procedure by roentgen television viewing has been chiefly responsible for the ease and accuracy with which the examination can now be performed. It is also an important factor in minimizing the risk inherent in all diagnostic needle puncture technics. The importance of close co-operation between the radiologist and the pathologist and the need for systematic training of personnel in the various aspects of this diagnostic procedure in obtaining good results is emphasized. The lack of any serious complication in the first 900 biopsies performed is reassuring and is a reflection of the organized approach used in the study of candidates for transthoracic needle biopsy. The illustrative material is well selected, and there are in most of the case reports a correlation of the roentgen findings with the histology of the specimens obtained. Some of the illustrations chosen to depict the roentgen character or differential appearance of malignant and benign infiltrates are not specific enough to permit appreciation of this difference. The clinical material consists of 574 needle biopsies in 408 patients with an age range of nine to eighty-three years. Presently, this diagnostic service is averaging 25 patients a month. Patients are punctured on an average of 1.4 times and occasionally as many as 5 times each. The technic is particularly suitable for the diagnosis of tumors. Inflammatory processes provide greater diagnostic difficulty. In the latter problem, obtaining bacteriologic studies in suspected inflammatory lesions was found helpful in establishing a correct diagnosis. In 13 per cent of the total material, it was not possible to obtain satisfactory cell material. It must be pointed out, however, that in a significant number of patients in this group the lesions were small.